How do naloxone-based interventions work to reduce overdose deaths: a realist review

BACKGROUND: Naloxone-based interventions as part of health systems can reverse an opioid overdose. Previous systematic reviews have identified the effectiveness of naloxone; however, the role of context and mechanisms for its use has not been explored. This realist systematic review aims to identify a theory of how naloxone works based on the contexts and mechanisms that contribute to the success of the intervention for improved outcomes. METHODS: Pre-registered at PROSPERO, this realist review followed RAMESES standards of reporting. Keywords included 'naloxone' and ' opioid overdose'. All study designs were included. Data extraction using 55 relevant outputs based on realist logic produced evidence of two middle-range theories: Naloxone Bystander Intervention Theory and Skills Transfer Theory. RESULTS: Harm reduction and/or low threshold contexts provide a non-judgemental approach which support in-group norms of helping and empower the social identity of the trained and untrained bystander. This context also creates the conditions necessary for skills transfer and diffusion of the intervention into social networks. Stigma and negative attitudes held by first responders and stakeholders involved in the implementation process, such as police or GPs, can prohibit the bystander response by inducing fear in responding. This interferes with skills transfer, naloxone use and carriage of naloxone kits. CONCLUSIONS: The findings provide theoretically informed guidance regarding the harm reduction contexts that are essential for the successful implementation of naloxone-based interventions. Peer-to-peer models of training are helpful as it reinforces social identity and successful skills transfer between bystanders. Health systems may want to assess the prevalence of, and take steps to reduce opioid-related stigma with key stakeholders in contexts using a low threshold training approach to build an environment  to support positive naloxone outcomes. TRIAL REGISTRATION: PROSPERO 2019 CRD42019141003. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12954-022-00599-4

Democratisation of Usable Machine Learning in Computer Vision

Many industries are now investing heavily in data science and automation to replace manual tasks and/or to help with decision making, especially in the realm of leveraging computer vision to automate many monitoring, inspection, and surveillance tasks. This has resulted in the emergence of the 'data scientist' who is conversant in statistical thinking, machine learning (ML), computer vision, and computer programming. However, as ML becomes more accessible to the general public and more aspects of ML become automated, applications leveraging computer vision are increasingly being created by non-experts with less opportunity for regulatory oversight. This points to the overall need for more educated responsibility for these lay-users of usable ML tools in order to mitigate potentially unethical ramifications. In this paper, we undertake a SWOT analysis to study the strengths, weaknesses, opportunities, and threats of building usable ML tools for mass adoption for important areas leveraging ML such as computer vision. The paper proposes a set of data science literacy criteria for educating and supporting lay-users in the responsible development and deployment of ML applications.Comment: 4 page

Acceptability and use of a patient-held communication tool for people living with dementia: a longitudinal qualitative study

Brendan McCormack - ORCID 0000-0001-8525-8905 https://orcid.org/0000-0001-8525-8905Replaced AM with VoR on 2020-05-19Objectives: To assess the acceptability and use of a low-cost patient-held communication tool.Design: Longitudinal Qualitative interviews at three time points over 18 months and document content analysisSetting: Primary and community servicesParticipants: Twenty-eight dyads - People living with dementia in Northern Ireland and their informal carers.Interventions: a patient-held healthcare “passport” for people living with dementia.Primary and secondary outcomes: acceptability and use of the passport – barriers and facilitators to successful engagement.Results: There was a qualified appreciation of the healthcare passport and a much more nuanced, individualistic or personalised approach to its desirability and use. How people perceive it and what they actually do with it, are strongly determined by individual contexts, dementia stage and other health problems, social and family needs and capacities. We noted concerns about privacy and ambivalence about engaging with health professionals.Conclusion: Such tools may be of use but there is a need for demanding, thoughtful, and nuanced programme delivery for future implementation in dementia care. The incentivisation and commitment of General Practitioners is crucial. Altering the asymmetrical relationship between professionals and patients requires more extensive attention.This study was supported by a grant from the R&D Division of the Northern Ireland Public Health Agency & Atlantic Philanthropies COM/5017/14https://doi.org/10.1136/bmjopen-2019-036249pubpu

The evaluation of a healthcare passport to improve quality of care and communication for people living with dementia (EQuIP): a protocol paper for a qualitative, longitudinal study

Background\ud \ud There is an urgent need for the development of simple communication tools that convey the strengths, assets, and healthcare needs of people living with dementia. A Healthcare Passport may improve communication with range of health and social support services, enhancing quality and continuity of care, and to permit a consideration of the challenges and how these might be managed effectively and compassionately. This study aims to evaluate the acceptability and use of this type of intervention for people living with dementia and their carers.\ud \ud \ud Methods/Design\ud \ud This is a qualitative longitudinal study informed by a critical realist review. The participants will be individuals identified as having mild-moderate dementia and informal carers. The in-depth interviews will occur at three points over the course of 18 months as they use the passport. This will be supplemented by analysis of the content of the passports and information from health and social care providers on the daily practicalities of using the passport in a range of healthcare settings.\ud \ud \ud Discussion\ud \ud By using a critical realist review and a qualitative, longitudinal approach, the study allows for the assessment of a complex intervention in a manner which goes beyond evaluating the basic efficacy of the passport, but looking more deeply at how it worked, for whom, and in what context. It has the potential to develop new data on how interventions improve communication across a range of service providers, while encouraging health and social care professionals to respect and encourage the development of self-management and retention of personhood throughout the progression of life-limiting illnesses

Incorporating the needs of ethnic minority and migrant communities in the policy process in Northern Ireland through the consultation of voluntary and community organisations

There has been a shift from top-down decision-making in many European countries in recent decades and a movement towards inclusive policy development. This is a key issue with regards to ethnic minority and migrant groups, who often experience poverty, social exclusion, and lower rates of participation in the political process. Almond and Verba (1963) found that the voluntary and community sector (VeS) plays a crucial intermediary role in political engagement. This method of political incorporation has been adopted by many Western democracies, and in the United Kingdom, policy towards the ves recognises the role of the sector in policy development. This research uses an evidence base from Northern Ireland to assess the efficacy of consulting the ves on behalf of ethnic minorities and migrants in policy development. Findings from interviews and document analysis in Northern Ireland showed that there are significant efforts made to engage ethnic minority and migrant groups in the policy process, and that the majority of this is done through the VCS. There are positives in this process, and examples of best practice do exist. However there is little evidence that the consultation process has been successful in reflecting the 'voice' of ethnic minorities in policy-making, particularly in the stages of implementation and monitoring. Borne out of Hooghe (2005)'s application of the Amsterdam model of political opportunity structure to ethnic minority movements, this thesis identifies four key factors which impact on the efficacy of the consultation process in representing the interests of ethnic minority and migrant groups in decision-making: the process of consultation; the systems and structures in which consultation takes place; the capacity and resources of stakeholders; and relationships between stakeholders. It argues that for this method to be effective, potential obstacles in each of these elements must be addressed.EThOS - Electronic Theses Online ServiceGBUnited Kingdo